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  • Rapidly progressive interstitial lung disease complicated by pulmonary interstitial emphysema in anti-MDA5 amyotrophic dermatomyositis

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Images in Thorax
Rapidly progressive interstitial lung disease complicated by pulmonary interstitial emphysema in anti-MDA5 amyotrophic dermatomyositis
  1. Sarrinder Kenyon1,
  2. David Careless2,3,
  3. Vidya Navaratnam4,5,
  4. Taryn Reddy1,6
  1. 1 Department of Medical Imaging, The Prince Charles Hospital, Chermside, Queensland, Australia
  2. 2 Department of General Medicine, St Andrew's Ipswich Private Hospital, Ipswich, Queensland, Australia
  3. 3 Department of General Medicine, Ipswich Hospital, Ipswich, Queensland, Australia
  4. 4 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
  5. 5 Curtin University Division of Health Sciences, Perth, Western Australia, Australia
  6. 6 Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
  1. Correspondence to Dr Taryn Reddy, Department of Medical Imaging, The Prince Charles Hospital, Chermside, QLD 4032, Australia; Taryn.Reddy{at}health.qld.gov.au

http://dx.doi.org/10.1136/thorax-2022-219859

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    A 37-year-old Caucasian man presented to hospital with septic arthritis of the right fifth metatarsophalangeal joint secondary to infected skin ulcers. In the preceding 6 months, he was diagnosed with anti-melanoma differentiation-associated gene 5 antibody positive amyotrophic dermatomyositis (anti-MDA5 ADM). His presenting symptoms were extrapulmonary, including skin ulcers which were felt to be immune mediated. A screening high resolution CT was performed at initial presentation to assess for interstitial lung disease (ILD), given the strong association with anti-MDA5 ADM.1 This showed mid and lower zone subpleural reticulation and ground glass change (figure 1A), which was attributed to his connective tissue disease. High-dose prednisolone was commenced, which was subsequently switched to mycophenolate to reduce steroid burden.

    Figure 1

    Images showing sequential changes in the lungs. (A) Baseline screening CT performed 5 months prior to admission, demonstrating minor ground glass and reticular changes right middle and right lower lobes. (B) CT chest performed pre-intubation, showing …

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    Footnotes

    • Contributors SK, DC, VN and TR were responsible for the conception and production of the case report. SK drafted the initial manuscript. SK and TR reviewed and edited the images. SK, TR and VN contributed to revising the manuscript critically for important intellectual content. DC provided additional clinical information and context and liaised with the patient’s family. All authors have reviewed the final draft of the manuscript submitted. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.